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LETTER TO EDITOR
Year : 2020  |  Volume : 9  |  Issue : 3  |  Page : 229-230

Infant feeding at the time of COVID-19: Is it safe to breastfeed?


Department of Pediatrics, Medical College, Umm Al-Qura University, Mecca; Department of Pediatrics, International Medical Center, Jeddah, Saudi Arabia

Date of Submission08-May-2020
Date of Decision24-Jun-2020
Date of Acceptance28-Jun-2020
Date of Web Publication07-Aug-2020

Correspondence Address:
Dr. Rafat Mohammed Mosalli
Department of Pediatrics, Umm Al-Qura University, P.O. Box 7607, Mecca
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcn.JCN_64_20

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How to cite this article:
Mosalli RM. Infant feeding at the time of COVID-19: Is it safe to breastfeed?. J Clin Neonatol 2020;9:229-30

How to cite this URL:
Mosalli RM. Infant feeding at the time of COVID-19: Is it safe to breastfeed?. J Clin Neonatol [serial online] 2020 [cited 2020 Sep 27];9:229-30. Available from: http://www.jcnonweb.com/text.asp?2020/9/3/229/291648



Recommendations regarding mother–infant contact and breastfeeding for mothers with COVID-19 are quite conflicting. Most reports and recommendations, however, acknowledge that postpartum contact with and breastfeeding might present potential risks for viral transmission from mothers with COVID-19 through respiratory droplet.[1] Health-care providers might judge on what in their opinion is ideal without considering parental decision about separation and feeding plan. In a recent letter, Almudeer states Based on the current and available data, breastfeeding benefits outweigh any potential risks of transmission of the virus through breastmilk,[2] without giving further details about the possible impact of virus transmission through direct breastfeeding and without seeking parental shared decision in order to comprehend this risk and perhaps explore other feeding options. We can assume at least some of the reasons behind selecting this choice: the undoubted protective benefits of breastfeeding together with lack of data supporting virus excretion in breast milk.[3] The current data, however, are still insufficient and should be carefully indorsed. To determine their best feeding option, both health-care providers and parents should fully understand the current evidence regarding potential risk of COVID transmission, maternal–newborn health status and hospital resources. Accordingly, there might be four possible feeding options: (1) expressed breast milk, (2) accepting the potential risk of direct breastfeeding, (3) bottled formula, and (4) donor milk. Natural or accepted medications for milk suppression may also be considered if the mother chooses not to breastfeed. Mothers with COVID-19 who are still considering breastfeeding should follow the Centers for Disease Control and Prevention infection control protocol before and after touching their baby.[4],[5] Alternatively, mother can express her breast milk during temporary separation, using a dedicated breast pump, as well as hand hygiene and thorough cleaning of the pump and its parts or bottle parts.[4],[5]

When a mother with COVID-19 is too sick to care for the newborn, the neonate will be managed separately and fed fresh expressed breast milk by designated healthy caregiver who should implement strict droplet, airborne and contact precautions until newborn SARS-CoV-2 PCR test results are available.[4],[5]

A donor human milk, though sounds an attractive option, might be impossible, given the social distancing and other constraint measures during the curfew.

In summary, health-care providers might encounter an infant born to a mother with suspected or confirmed COVID-19 for which postpartum contact and/or breastfeeding might present potential risks of viral transmission, while the beneficial effects of breastfeeding are fully recognized universally, a well-balanced discussion with the parents for or against breastfeeding should be an informed decision and address the followings: risks and benefits of breastfeeding, including the limited available data on excretion of virus through breast milk, potential presence of viral antibodies, risks of infection via health-care providers and the care needed during handling the neonate to avoid infection, as well as the alternative feeding options such as expressed breast milk, donor milk (if available) and/or formula.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Zeng L, Xia S, Yuan W, Yan K, Xiao F, Shao J, et al. Neonatal early-onset infection with SARS-CoV-2 in 33 neonates born to mothers with COVID-19 in Wuhan, China. JAMA Pediatr Published online March 26, 2020: e200878 doi:10.1001/jamapediatrics.2020.0878.  Back to cited text no. 1
    
2.
Almudeer A, Alallah J, AlSaedi S, Anabrees J, Kattan A, AlSalam Z, et al. Recommendations for the management of newborn with suspected or confirmed coronavirus disease-19. J Clin Neonatol 2020; 9:93-7.  Back to cited text no. 2
  [Full text]  
3.
Chen H, Guo J, Wang C, Luo F, Yu X, Zhang W, et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: A retrospective review of medical records. Lancet 2020;395:809-15.  Back to cited text no. 3
    
4.
Centers for Disease Control and Presentation Pregnancy and Breastfeeding Information about Coronavirus Disease; 2019. Available from: https://www.cdc.gov/coronavirus/2019-ncov/prepare/pregnancy-breastfeeding.html. [Last accessed on 2020 Apr 02].  Back to cited text no. 4
    
5.
Puopolo KM, Hudak ML, Kimberlin DW, Cummings J. Management of infants born to mothers with COVID-19. American academy of pediatrics committee on fetus and newborn, section on neonatal perinatal medicine, and committee on infectious diseases. April 2, 2020.  Back to cited text no. 5
    




 

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